Provider-patient communication is central to patient care. The manner in which diagnostic and treatment decisions are discussed may influence patient adherence to provider recommendations, and in turn, patient health outcomes. Studies have shown that patients who receive more information during an office visit are more satisfied with their care, recall more information, and are more adherent to treatment plans. Those who participate more when they interact with their providers have better health outcomes. However, a significant obstacle to the amount of information provided is the limited amount of time providers have for office visits, during which they must perform health maintenance and disease management tasks, address patient concerns, and provide patient education about patient medical conditions and treatments. Efficient yet effective communication is needed to navigate these visits, but optimal communication strategies for dealing with multiple competing demands during outpatient visits have not been well explored. The overall objective of this study is to identify effective and efficient provider-patient communication strategies during primary care outpatient visits. Qualitative analysis of existing audio recordings will be used to develop a coding system describing efficient and effective provider and patient communication. This analysis will inform the development of a measure of communication efficiency and effectiveness. Subsequently, primary care physicians and their patients will be recruited for the study, and have their office visits audio taped. Patients and providers will complete surveys to assess the relationship of their attitudes and values, and the physician-patient relationship on communication efficiency and effectiveness. The study also will explore the relationship between communication efficiency on patient intention to adhere to treatment recommendations, and patient and provider satisfaction with the visit. A subset of patients and providers will be interviewed concerning their impressions of the visit communication, and their understanding of what transpired during the visit. Findings will be used to develop physician- and patient-targeted interventions to promote efficient, effective communication during office visits that maximize patient understanding and satisfaction.